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A nationwide survey of radiation oncologists' management practices of radiation-induced skin reaction (RISK)

Published online by Cambridge University Press:  01 December 2009

Uma Swamy ,
Hani Ashamalla  and
Adel Guirguis
Uma Swamy*
Affiliation:
Radiation Oncology, New York Methodist Hospital, Weill Medical College, Cornell University, 506, 6th Street, Brooklyn, NY 11215, USA
Hani Ashamalla
Affiliation:
Radiation Oncology, New York Methodist Hospital, Weill Medical College, Cornell University, 506, 6th Street, Brooklyn, NY 11215, USA
Adel Guirguis
Affiliation:
Radiation Oncology, New York Methodist Hospital, Weill Medical College, Cornell University, 506, 6th Street, Brooklyn, NY 11215, USA
*
Correspondence to: Uma Swamy, Department of Radiation Oncology, New York Methodist Hospital, 506, 6th Street, Brooklyn, NY 11215, USA. E-mail: uswamy@gmail.com
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Abstract

Purpose: A questionnaire was developed to explore variations among radiation oncologists in managing early-stage breast cancer, specifically radiation-induced skin reaction (RISK).

Materials and methods: A survey was designed to target a database of 962 radiation oncologists, self-identified as ‘interested in treatment of breast cancer’. This database was obtained from the American Society of Therapeutic Radiology & Oncology (ASTRO). Participants submitted the survey online or by mail. Overall response to the survey was 282 out of 962 (29.3%). Data were handled as rates.

Results: Out of 282 respondents, 275 (97.5%) agreed on delivering 4500–5040 cGy. The most frequently employed dose was 5040/180 cGy. Three-dimensional-conformal (3DCRT) treatment was used by 55.4%, intensity-modulated radiotherapy (IMRT) by 24.5%, and conventional by 20.1%. Almost all (92.5%) agreed on using boost in ductal carcinoma in situ (DCIS). Image-guided boost placement (IGBP) was used by 87.3%. Boost dose included variations: 50.2, 7.3, and 18% used 1000, 1200, and 1400 cGy, respectively; the remaining used higher doses. In management of RISK, Aquaphor was the most popular agent (72.1%). Other agents were utilized either alone or in combination. Almost all (99%) agreed that large breast size increases RISK.

Conclusion: This survey offers a glimpse of management practices in early-stage breast cancer amongst a cross-section of radiation oncologists in the United States. Although there appears to be an overall congruence on the doses and techniques of radiation delivery, the management of RISK is varied. Additional efforts are warranted to standardize practices in order to practice evidence based medicine in a cost-effective manner.

Keywords

Radiation reactionsurveybreast cancerskin reaction
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 8 , Issue 4 , December 2009 , pp. 195 - 205
Copyright
Copyright © Cambridge University Press 2009

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References

Porock, D, Kristjanson, L. Skin reactions during radiotherapy for breast cancer: the use and impact of topical agents and dressings. Eur J Cancer Care 1999; 8:143–153.CrossRefGoogle ScholarPubMed
Freedman, GM, Anderson, PR, Goldstein, LJ, et al. Four-week course of radiation for breast cancer using hypofractionated intensity modulated radiation therapy with an incorporated boost. Int J Radiat Oncol Biol Phys. 2007; 68:347–353.CrossRefGoogle ScholarPubMed
White, J, Joiner, M. Toxicity from radiation in breast cancer. In: Small, W, Woloschak, GE, (ed). Radiation Toxicity: A Practical Guide. 1st edition. Chicago: Springer, 2006, pp. 65–81.Google Scholar
The Research Profession Tracking Study. Published by CMOR, A division of the Marketing Research Association (MRA).Google Scholar
Ballou, J, Roff, B, Milliner-Waddell, J, Potter, F. Developing a Prescription for Physician Surveys. Paper presented at American Association For Public Opinion Association, Miami Beach, FL 2008-10-10 http://www.allacademic.com/meta/p17148_index.html.Google Scholar
National Institutes of Health Consensus Development Conference Statement: Adjuvant therapy for breast cancer, 1–3 November 2000. J Natl Cancer Inst Monogr 2001:5–15.Google Scholar
Veronesi, U, Marubini, E, Mariani, L, Galimberti, V, Luini, A, Veronesi, P, Salvadori, B, Zucali, R. Radiotherapy after breast conserving surgery in small breast carcinoma: long term results of a randomized trial. Ann Oncol 2001; 12:997–1003.CrossRefGoogle ScholarPubMed
Fisher, B, Anderson, S, Bryant, J, Margolese, RG, Deutsch, M, Fisher, ER, Jeong, JH, Wolmark, N. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 2002; 347:1233–1241.CrossRefGoogle ScholarPubMed
Veronesi, U, Cascinelli, N, Mariani, L, Greco, M, Saccozzi, R, Luini, A, Aguilar, M, Marubini, E. Twenty year follow up of a randomized study comparing breast conserving surgery with radical mastectomy for early breast cancer. N. Engl J Med 2002; 347:1227–1232.CrossRefGoogle ScholarPubMed
Van Dongen, JA, Voogd, AC, Fentiman, ISet al. Long term results of a randomized trial comparing breast conserving therapy with mastectomy: European organization for research and treatment of cancer 10801 trial. J Natl Cancer Inst 2000; 92:1143–1150.CrossRefGoogle ScholarPubMed
Veronesi, U, Marubini, E, Mariani, L, Galimberti, V, Luini, A, Veronesi, P, Salvadori, B, Zucali, R. Radiotherapy after breast-conserving surgery in small breast carcinoma: long term results of a randomized trial. Ann Oncol 2001; 12:997–1003.CrossRefGoogle ScholarPubMed
Fisher, B, Bryant, J, Dignam, JJet al. Tamoxifen, radiation therapy, or both for prevention of ipsilateral breast tumor recurrence after lumpectomy in women with invasive breast cancers of one centimeter or less. J Clin Oncol 2002; 20:4141–4149.CrossRefGoogle ScholarPubMed
Forrest, AP, Stewart, HJ, Everington, D, Prescott, RJ, McArdle, CS, Harnett, AN, Smith, DC, George, WD. Randomised controlled trial of conservation therapy for breast cancer: 6-year analysis of the Scottish Trial. Lancet 1996; 348:708–713.CrossRefGoogle ScholarPubMed
START Trialists’ Group, Bentzen, SM, Agarwal, RKet al. The UK Standardisation of Breast Radiotherapy (START) Trial B of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet 2008; 371:1098–1107.Google ScholarPubMed
START Trialists’ Group, Bentzen, SM, Agrawal, RKet al. The UK Standardisation of Breast Radiotherapy (START) Trial A of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet Oncol 2008; 9:331–341.Google Scholar
Owen, J, Ashton, A, Bliss, J, Homewood, J, Harper, C, Hanson, J, Haviland, J, Bentzen, S, Yarnold, J. Effect of radiotherapy fraction size on tumour control in patients with early-stage breast cancer after local tumour excision: long-term results of a randomised trial. Lancet Oncol 2006; 7:467–471.CrossRefGoogle ScholarPubMed
Yarnold, J, Ashton, A, Bliss, J, Homewood, J, Harper, C, Hanson, J, Haviland, J, Bentzen, S, Owen, R. Fractionation sensitivity and dose response of late adverse effects in the breast after radiotherapy for early breast cancer: long-term results of a randomised trial. Radiother Oncol 2005; 75:9–17.CrossRefGoogle ScholarPubMed
Whelan, TJ, et al. Long term results of a randomized trial of accelerated hypofractionated whole breast irradiation following breast conserving surgery in women with node negative breast cancer. 2008 American Society for Therapeutic Radiology and Oncology (ASTRO) Plenary Session.CrossRefGoogle Scholar
Pierce, LJ, Moughan, J, White, J, Winchester, DP, Owen, J, Wilson, JF. 1998–1999 Patterns of care process survey of national breast cancer. Int J Radiat Oncol Biol Phys 2005; 62:183–192.CrossRefGoogle Scholar
Taylor, M, Perez, C, Halverson, Ket al. Factors influencing cosmetic results after conservation therapy for breast cancer. Int J Radiat Oncol Biol Phys 1995; 31:753–764CrossRefGoogle ScholarPubMed
Wazer, DE, DiPetrillo, T, Schmidt-Ullrich, R, Weld, L, Smith, TJ, Marchant, DJ, Robert, NJ. Factors influencing cosmetic outcome and complication risk after conservative surgery and radiotherapy for early-stage breast carcinoma. J Clin Oncol 1992; 10:356–363.CrossRefGoogle ScholarPubMed
Donovan, E, Bleakley, N, Denholm, Eet al. Randomised trial of standard 2D radiotherapy (RT) versus intensity modulated radiotherapy (IMRT) in patients prescribed breast radiotherapy. Radiother Oncol 2007; 82:254–264.CrossRefGoogle ScholarPubMed
Pignol, JP, Olivotto, I, Rakovitch, Eet al. A multicenter randomized trial of breast intensity-modulated radiation therapy to reduce acute radiation dermatitis. J Clin Oncol 2008; 26:2085–2092.CrossRefGoogle ScholarPubMed
Harsolia, A, Kestin, L, Grills, Iet al. Intensity-modulated radiotherapy results in significant decrease in clinical toxicities compared with conventional wedge-based breast radiotherapy. Int J Radiat Oncol Biol Phys 2007; 68:1375–1380.CrossRefGoogle ScholarPubMed
Freedman, GM, Anderson, PR, Li, J, Eisenberg, DF, Hanlon, AL, Wang, L, Nicolaou, N. Intensity modulated radiation therapy (IMRT) decreases acute skin toxicity for women receiving radiation for breast cancer. Am J Clin Oncol 2006; 29:66–70.CrossRefGoogle ScholarPubMed
Yerushalmi, R. Radiation treatment for ductal carcinoma in situ (DCIS): is a boost to the tumor bed necessary? Neoplasma 2006; 53:507–510.Google Scholar
Omlin, A, Amichetti, M, Azria, Det al. Boost radiotherapy in young women with ductal carcinoma in situ: a multicentre, retrospective study of the Rare Cancer Network. Lancet Oncol 2006; 7:652–666.CrossRefGoogle ScholarPubMed
Bartelink, H, Horiot, JC, Poortmans, Pet al. Recurrence rates after treatment of breast cancer with standard radiotherapy with or without additional radiation. N Engl J Med 2001; 345:1378–1387.CrossRefGoogle ScholarPubMed
Bartelink, H, Horiot, JC, Poortmans, Pet al. Impact of higher radiation dose on local control and survival in breast conserving therapy of early breast cancer: 10-year results of the randomized boost versus no boost EORTC 22881-10882 trial. J Clin Oncol 2007; 25:3259–3265.CrossRefGoogle ScholarPubMed
Romestaing, P, Lehingue, Y, Carrie, C, Coquard, R, Montbarbon, X, Ardiet, JM, Mamelle, N, Gérard, JP. Role of a 10 Gy boost in the conservative treatment of early breast cancer: results of a randomized trial. J Clin Oncol 1997; 15:963–968.CrossRefGoogle Scholar
Julian, TB, Land, SR, Wang, Y, et al. Is boost therapy necessary in the treatment of DCIS? J Clin Oncol 26: 2008 (May 20 suppl; abstr 537)CrossRefGoogle Scholar
Vreling, C, Collette, L, Fourquet, Aet al. The influence of the boost in breast conserving therapy on cosmetic outcome in the EORTC boost versus no boost trial. Int J Radiat Oncol Biol Phys 1999; 45:677–685.CrossRefGoogle Scholar
Oh, KS, Kong, F-M, Griffith, KA, Yanke, B, Pierce, LJ. Planning the breast tumor bed boost: changes in the excision cavity volume and surgical scar location after breast-conserving surgery and whole breast irradiation. Int J Radiat Oncol Biol Phys 2006; 66:680–686.CrossRefGoogle ScholarPubMed
Benda, RK, Yasuda, G, Sethi, A, Gabram, SG, Hinerman, RW, Mendenhall, NP. Breast boost: are we missing the target? Cancer 2003; 97:905–909.CrossRefGoogle ScholarPubMed
Jacobson, G, Betts, V, Smith, B. Change in volume of lumpectomy cavity during external beam irradiation of the intact breast. Int J Radiat Oncol Biol Phys 2006; 65:1161–1164.CrossRefGoogle ScholarPubMed
Bates, AT, Swift, CL, Kwa, W, Moravan, V, Aquino-Parsons, C. A computed tomography-based protocol vs conventional clinical mark-up for breast electron boost. Clin Oncol (R Coll Radiol) 2007; 19:349–355.CrossRefGoogle ScholarPubMed
Smitt, MC, Birdwell, RL, Goffinet, DR. Breast electron boost planning: comparison of CT and US. Radiology 2001; 219:203–206.CrossRefGoogle Scholar
Fisher, J, Scott, C, Stevens, R, et al. Randomized phase III study comparing best supportive care to Biafine® as a prophylactic agent for radiation induced skin toxicity for women undergoing breast radiation: RTOG 97–13. Int J Radiat Oncol Biol Phys 2000; 48:1307–1310.CrossRefGoogle ScholarPubMed
Roy, I, Fortin, A, Larochelle, M. The impact of skin washing with water and soap during breast irradiation: a randomized study. Radiother Oncol 2001; 58:333–339.CrossRefGoogle ScholarPubMed
Løkkevik, E, Skovlund, E, Reitan, JB, Hannisdal, E, Tanum, G. Skin treatment with bepanthen cream versus no cream during radiotherapy. Acta Oncol 1996; 35:1021–1026.CrossRefGoogle ScholarPubMed
Maiche, A, Isokangas, O, Grohn, P. Skin protection by sucralfate cream during electron beam therapy. Acta Oncol 1994; 33:201–203.CrossRefGoogle ScholarPubMed
Maiche, AG, Grohn, P, Maki-Hokkonen, H. Effect of chamomile cream and almond ointment on acute radiation skin reaction. Acta Oncol 1991; 30:395–396.Google ScholarPubMed
Liguori, V, Guillemin, C, Pesce, GF, Mirimanoff, RO, Bernier, J. Double blind randomized clinical study comparing hyaluronic acid cream to placebo in patients treated with radiotherapy. Radiother Oncol 1997; 42:155–161.CrossRefGoogle ScholarPubMed
Williams, M, Burk, M, Loprinzi, Cet al. Phase III double blind evaluation of an aloe vera gel as a prophylactic agent for radiation induced skin toxicity. Int J Radiat Oncol Biol Phys 1996; 36:345–349.CrossRefGoogle ScholarPubMed
Heggie, S, Bryant, GP, Tripcony, L, Keller, J, Rose, P, Glendenning, M, Heath, J. A phase III study on the efficacy of topical aloe vera gel on irradiated breast tissue. Cancer Nurs 2002; 25:442–451.CrossRefGoogle ScholarPubMed
Olsen, DL, Raub, W Jr, Bradley, C, Johnson, M, Macias, JL, Love, V, Markoe, A. The effect of aloe vera gel/mild soap versus mild soap alone in preventing skin reactions in patients undergoing radiation therapy. Oncol Nurs Forum 2001; 28:543–547.Google ScholarPubMed
Bostrom, A, Lindman, H, Swartling, C, et al. Potent corticosteroid therapy (mometasone furoate) significantly reduced acute radiation dermatitis: results from a double-blind, randomized study. Radiother Oncol 2001; 59:257–265.CrossRefGoogle ScholarPubMed
Schmuth, M, Wimmer, MA, Hofer, S, Sztankay, A, Weinlich, G, Linder, DM, Elias, PM, Fritsch, PO, Fritsch, E. Topical corticosteroid therapy for acute radiation dermatitis: a prospective randomized double blind study. Br J Dermatol 2002; 146:983–991.CrossRefGoogle ScholarPubMed
Potera, M, Lookingbill, D, Stryker, J. Prophylaxis of radiation dermatitis with topical cortisone cream. Radiology 1982; 143:775–777.CrossRefGoogle ScholarPubMed
Szumacher, E, Wighton, A, Franssen, Eet al. Phase II study assessing the effectiveness of Biafine® cream as a prophylactic agent for radiation-induced acute skin toxicity to the breast in women undergoing radiotherapy with concomitant CMF chemotherapy. Int J Radiat Oncol Biol Phys 2001; 51:81–86.CrossRefGoogle Scholar
Fenig, E, Brenner, B, Katz, A, Sulkes, J, Lapidot, M, Schachter, J, Malik, H, Sulkes, A, Gutman, H. Topical Biafine and Lipiderm for the prevention of radiation dermatitis: A randomized prospective trial. Once Rep 2001; 8:305–309.Google ScholarPubMed
Pommier, P, Gomez, F, Sunyach, MP, D’Hombres, A, Carrie, C, Montbarbon, X. Phase III randomized trial of Calendula officinalis compared with Trolamine for the prevention of acute dermatitis during irradiation of breast cancer. J Clin Oncol 2004; 22:1447–1453.CrossRefGoogle Scholar
www.drugstore.com. Accessed 18 May 2009.Google Scholar
Pezner, RD, Patterson, MP, Lipsett, JA, Odom-Maryon, T, Vora, NL, Wong, JY, Luk, KH. Factors affecting cosmetic outcome in breast-conserving cancer treatment-objective quantitative assessment. Breast Cancer Rest Treat 1991; 20:85–92.CrossRefGoogle Scholar
Ryoo, M, Kagan, AR, Wollin, Met al. Prognostic factors for recurrence and cosmesis in 393 patients after radiation therapy for early mammary carcinoma? Radiology 1989; 172:555–559.CrossRefGoogle ScholarPubMed
de la Rochefordière, A, Abner, AL, Silver, B, Vicini, F, Recht, A, Harris, JR. Are cosmetic results following conservative surgery and radiation therapy for early breast cancer dependent on technique? Int J Radiat Oncol Biol Phys 1992; 23:925–931.CrossRefGoogle ScholarPubMed
Taylor, M, Perez, C, Halverson, Ket al. Factors influencing cosmetic results after conservation therapy for breast cancer. Int J Radiat Oncol Biol Phys 1995; 31:753–764.CrossRefGoogle ScholarPubMed
Grann, A, McCormick, B, Chabner, ES, Gollamudi, SV, Schupak, KD, Mychalczak, BR, Heerdt, AS, Merchant, TE, Hunt, MA. Prone breast radiotherapy in early-stage breast cancer: a preliminary analysis. Int J Radiat Oncol Biol Phys 2000; 47:319–325.CrossRefGoogle ScholarPubMed
Mahe, MA, Classe, JM, Dravet, F, Cussac, A, Cuilliere, JCPreliminary results for prone-position breast irradiation. Int J Radiat Oncol Biol Phys 2002; 52:156–160.CrossRefGoogle ScholarPubMed